Stalking: Psychiatric Perspectives and Practical Approaches

Stalking is a form of domestic terrorism in our age. Accordingly, mental health professionals must be prepared to deal with both stalkers and their victims. The media is mostly focused on the criminal and his or her exposure and prosecution. Victim advocacy organizations and publications are more concerned with the specifics of the traumatic experience. Thus, despite the interest in this hot topic, a multidimensional approach to stalking that includes a psychiatric perspective is missing. Dr. Pinals and contributing authors, from the Group for the Advancement of Psychiatry’s Committee on Psychiatry and the Law, provide a comprehensive analysis of the psychological, social, developmental, and legal dimensions of stalking. Case vignettes and public records of stalking incidents make the book highly illustrative and understandable.

The term “stalking” in psychiatric literature and works of fiction is historically associated with erotomania, nymphomania, obsessive attachment, obscenities, threats, paranoia, and irrationality. Although various definitions of stalking exist, it is generally defined as repeated acts or behavior that is experienced as unpleasantly intrusive by the victim and that creates feelings of apprehension. A victim of stalking may be subject to unwanted phone calls, letters, cards, faxes, e-mails, and gifts or even surveillance, threats, or actual harm. The reported prevalence of victimization for women (8% to 33%) is remarkably high. College students, mental health professionals, and women are at a somewhat greater risk of being stalked.

The clinical aspects of stalking, including its classification and typology, are summarized and explained through case examples. The authors propose that understanding the typological psychology of stalkers improves the ability to ascertain and mitigate the risks posed by stalking behavior. Factors such as substance use, criminal history, relationship history, and suicidality and suicidality-related violence (including acts of homicide) are discussed. The authors suggest clinical, legal, and practical methods for the management of stalking behavior. However, most of the methods suggested seem to be legal and forensic interventions, which disappointed my expectations for a more psychotherapeutic approach. One interesting case example describes a mental health worker as a victim of stalking. The authors advocate that mental health professionals set a firm therapeutic boundary in order to reduce stalking behavior by patients. The authors also recognize the complexity of the psychopathology of stalking and the necessity of tailor-made approaches to its management.

The victimology and psychological consequences of stalking resemble forms of posttraumatic stress disorder. Management strategies for victims of stalking are also described through interesting case examples. The book continues with a discussion of stalking and the law, including recent trends in anti-stalking legislation, competency, and criminal responsibility.

The final section includes an intriguing account of cyber stalking. The authors point out that cyber stalking is still not completely understood. Despite some differences between cyber stalkers and stalkers in general, cyber stalkers may also assault their victims. Although the uncertain prevalence and typology of this new behavior requires further research, there are some suggested management strategies from the authors. Another special topic is juvenile stalking. Unfortunately, help for juvenile victims, who often cannot defend themselves as well as adults, is not described. Although the authors point out that celebrities do not reflect the majority of cases and that most stalking occurs between people who know each other, there is a full chapter describing the stalking of celebrity targets such as Madonna and Steven Spielberg.

Despite the foreword, in which the authors warn against offering diagnostic labels without analysis of the root causes of the problematic behavior, the authors’ approach to the subject of stalking seems to be more descriptive forensic psychiatry than psychodynamic insight. The origins of stalking behavior and its relationship to violence, destructiveness, malignant aggression, and personality disorders are mentioned only briefly. Nevertheless, the book presents a very informative approach that summarizes recent research findings and provides vignettes of management strategies that can be a useful guide for professionals working in forensic psychiatry and law enforcement.